head and facial disorders Flashcards
etiolgy of bell’s palsy
- idiopathic
- might be associated with HSV
what conditions increase risk for bell’s palsy
- pregnancy
- diabetes
clinical presentation
- sudden onset of unilateral facial paralysis
- inability to close eye
- facial drooping
- decreased tearing
- hyperacusis
- +/- lost of taste to anterior 2/3 of tongue
- bell’s palsy
bell’s palsy
- acute facial nerve palsy
- LMN lesion affecting ipsilateral side of face, involves entire side
ramsay hunt syndrome
- cephalic zoster with facial nerve involvement or herpes zoster oticus
- evaluate for vesicles near external meatus
what differentiates bell’s palsy symtpoms from lyme disease
- lyme disease can affect facial nerve but typically bilateral involvement lasting less than 2 months
how would a central facial palsy (UMN lesion) present
- UMN lesion affects contralateral portion of lower face
- can still raise eyebrows
how is bell’s palsy diagnosed
- clinical diagnosis
max severity of bell’s palsy should be reached within what time frame
- progressive with max seveity within 3 weeks
when should diagnostic studies be considered in assessment of suspected bell’s palsy
- atypical symptoms
- no significant improvement in 4 months
- progression beyong 3 weeks
treatment of bell’s palsy
- prednisone x 5-7 days
- +/- valacyclovir
- best results if tx initiated within 3 days of symptoms onset
- artificial tears applied hourly
duration of symptoms of bell’s palsy
- majority improve within 3 weeks with normal function returning in 3-6 months
- recurrence rate 7-15%
What is Trigeminal Neuralgia?
- recurrent brief episodes of severe, unilateral pain along 5th cranial nerve
- pain is electrical “shock-like” sensation
patient population affected in Trigeminal Neuralgia
- W >M
- > 50 yo
- family association rare
Trigeminal Neuralgia can be classified into what two groups
- classic: idiopathic or vascular compression of trigeminal nerve root
-
painful trigeminal neuropathy (secondary)
- causes: multiple sclerosis
in Trigeminal Neuralgia, compression of trigeminal nerve causes
demyelination
Trigeminal Neuralgia typically affects what part of 5th cranial nerve
- unilateral
-
V2 > V3 > V1
- V1 may be associated with autonomic symptoms
tiggers of Trigeminal Neuralgia
- light touch
- chewing, talking, shaving, brushing teeth
what is pretrigeminal neuralgia
- continuous, dull ache in jaw prior to classic symptoms of Trigeminal Neuralgia
how is Trigeminal Neuralgia diagnosed
- at least 3 paroxysmal episodes of unilateral facial attacks: severe intensity, shock-like pain
- affects trigeminal nerve distribution only
- no neurological deficits
**may need to r/o other causes: MRI/MRA
treatment of Trigeminal Neuralgia
-
carbamazepine
- +/- Baclofen
What is Temporal arteritis
- giant cell arteritis
- chronic vasculitis of large and medium vessels
- wall thickening and decreased lumen
Temporal arteritis can lead to what two serious conditions
- ophthalmic artery occlusion: blindness
- basilar artery occlusion: brain stem infarct
Temporal arteritis commonly affects what patient population
- > 50 yo
- F>M
clinical presentation
- new headache, unilateral, severe
- visual disturbances
- polymyalgia rheumatica
- jaw claudication
- fever
Temporal arteritis
physical exam for Temporal arteritis should include
- vision evaluation
- temporal artery palpation: will be tender with decreased or absent pulse
- ausculate for bruits
- check carotid bruits
how is Temporal arteritis diagnosed
need 3/5
- ESR > 50 mm/hr
- age of onset > 50 y.o.
- new, localized headache
- temporal artery tenderness, decreased temporal pulse
- temporal artery biopsy
- 2cm section of artery
- presence of multi-nucleated cells” diagnostic
- 2cm section of artery
treatment of Temporal arteritis
-
glucocorticoid treatment - prednisone
- high suspicion, start tx prior to confirming dx
what is temporomandibular joint dysfunction
- pain associated with TMJ misalignment
- muscular hypertrophy with malocclusion
- arthritis
what puts someone at a high risk for temporomandibular joint (TMJ) dysfunction
- rheumatoid arthritis
- ? mood and psychiatric disorder
clinical presentation
- periauricular pain and tenderness of TMJ and muscles of mastication
- crepitus of jaw with movement
- decreased jaw ROM
temporomandibular joint dysfunction
treatment of temporomandibular joint dysfunction
- NSAIDS, tylenol, TCAs
